Diagnosis and management of the lateralized tympanic membrane.

Abstract

Lateralization of the tympanic membrane (TM) is associated with significant morbidity. In a series of 14 patients, we make observations to illuminate this condition for the diagnosing and treating physician. Chart review of 14 consecutively treated patients. We analyzed the presenting signs and symptoms, etiology, audiometric data, and operative findings of patients with a lateralized tympanic membrane (TM). The etiology was postsurgical in 13 patients (there were four aural atresia repairs and nine tympanoplasties), with 2 patients having had multiple previous surgeries. Presentation averaged more than 5 years after the latest surgery. Presenting symptoms included hearing loss in 10, tinnitus in 3, vertigo in 3, and otorrhea in 2 patients; 3 patients were nonsymptomatic at the time of presentation. The average air-bone gaps were 39 dB before treatment and 29 dB after treatment. Operative findings included cholesteatoma in six patients. Eight patients healed with the TM in the normal position; one had TM retraction, one had a TM perforation, and three had a recurrent lateralization. The lateralized TM is primarily, but not necessarily, a complication of otological surgery. It may be associated with considerable morbidity, including hearing loss and cholesteatoma. Patients may present several years after their surgery, occasionally as an incidental finding. Surgical repair is often necessary for significant underlying disease, but re-establishment of a normal TM can be challenging.